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FORM A APPLICATION FOR APPROVAL TO CONSTRUCT AN ANIMAL DISPLAY ESTABLISHMENT (FIXED OR OFF-DISPLAY ESTABLISHMENTS ONLY) INFORMATION FOR APPLICANTS Definitions: construct means “erect” or “convert premises into”. fixed establishment means an animal display establishment comprising premises used, on an ongoing basis, for the display, and the keeping for display, of animals, not being the following: a) a mobile establishment, and b) an off-display establishment. off-display establishment means an animal display establishment comprising premises used for the keeping for display of animals, but not the display of animals, that are: a) the subject of an approval under section 22 of the Act, or b) the subject of a permit, or c) ordinarily exhibited at a fixed establishment, and includes the land, buildings, enclosures and facilities used for that purpose. To apply for approval to construct a fixed establishment or off-display establishment: Detach the front “Information for Applicants” section , pages i - v, and retain for reference Complete the application form, attaching: o the $230 lodgement fee (cheques should be made payable to NSW Department of Primary Industries), (credit card details may be provided – see page 11), and o all documents referred to in the application form (including fully completed Form Gs and Form Ds (if relevant), their lodgement fees and the documents referred to in those INT19/24023 Page i

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Page 1: Form A: Application to construct an animal display ... · Web view(credit card details may be provided – see page 11), and all documents referred to in the application form (including

FORM AAPPLICATION FOR APPROVAL TO CONSTRUCT AN ANIMAL

DISPLAY ESTABLISHMENT (FIXED OR OFF-DISPLAY ESTABLISHMENTS ONLY)

INFORMATION FOR APPLICANTS

Definitions:construct means “erect” or “convert premises into”.fixed establishment means an animal display establishment comprising premises used, on an ongoing basis, for the display, and the keeping for display, of animals, not being the following:

a) a mobile establishment, andb) an off-display establishment.

off-display establishment means an animal display establishment comprising premises used for the keeping for display of animals, but not the display of animals, that are:

a) the subject of an approval under section 22 of the Act, or

b) the subject of a permit, or c) ordinarily exhibited at a fixed establishment,

and includes the land, buildings, enclosures and facilities used for that purpose.

To apply for approval to construct a fixed establishment or off-display establishment:

Detach the front “Information for Applicants” section , pages i - v, and retain for reference

Complete the application form, attaching:o the $230 lodgement fee

(cheques should be made payable to NSW Department of Primary Industries), (credit card details may be provided – see page 11),

ando all documents referred to in the application form (including fully completed Form

Gs and Form Ds (if relevant), their lodgement fees and the documents referred to in those application forms).

Return the completed form by:o preferred method: emailing a pdf file of the completed, signed form(s),

attachments and credit card details to [email protected]

o posting the completed, signed form(s) and attachments, including lodgement fees to:

Exhibited AnimalsBiosecurity and Food Safety Compliance The Department of Primary Industries Locked Bag 21

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ORANGE NSW 2800

Any application that is not accompanied by the relevant fee(s) and supporting documents referred to in this form will be returned without further assessment.

HOW WILL YOUR APPLICATION BE ASSESSED?

Approval to construct a fixed establishment or an off-display establishment cannot be issued unless the Secretary (or delegate) is satisfied that the fixed establishment or off-display establishment will conform to and be conducted in accordance with the prescribed standards.

You should ensure that you understand all applicable legislation and standards. The names of prescribed standards are listed in the Exhibited Animal Protection Regulation 2010.

You can download the Exhibited Animals Protection Act 1986 and the Exhibited Animals Protection Regulation 2010 from the NSW Legislation Website at:

http://www.legislation.nsw.gov.au/

You can download copies of the relevant prescribed standards from:

https://www.dpi.nsw.gov.au/animals-and-livestock/animal-welfare/exhibit

WHAT FORMS DO YOU NEED TO SUBMIT?

1. A fully completed “Form A: Application for Approval to Construct an Animal Display Establishment (Fixed or Off-display Establishments Only)” that relates to the premises you propose to use as a fixed establishment or off-display establishment. It must be accompanied by a $230 lodgement fee and any documents referred to in Form A.

2. A fully completed “Form G: Application for Approval for Construction or Alteration at a Fixed or Off-display Establishment” for each proposed animal enclosure (including display, off-display and health management enclosures and the outer property fence) and each proposed animal support facility (including food preparation and feed storage facilities, animal treatment area and post mortem facilities) at the premises you propose to use as a fixed establishment or off-display establishment. Each Form G must be accompanied by a $46 lodgement fee and any documents referred to in the Form G.

3. A fully completed “Form D: Application for a Permit to Exhibit a Prescribed Species” for each prescribed species you have listed in your answer to Question 13 in Form A. Only some species are prescribed species and they are listed in Schedule 2 of the Exhibited Animals Protection Regulation 2010 (See “Permits for Certain Animals” below.) A separate Form D must be submitted for each prescribed species and each Form D must be accompanied by a $23 lodgement fee and any documents referred to in the Form D.

Note: Applicants whose off-display establishment (or home base) is outside NSW are not required to submit an application for approval of their off-display establishment.

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THE ASSESSMENT PROCESS

APPLICATION FORMS SUBMITTED WITHOUT FEES OR DOCUMENTSYour application forms will first be reviewed by a departmental assessor to ensure the forms are accompanied by:

a) the relevant fees; and b) any documents referred to in the forms.

It is a requirement of the Exhibited Animals Protection Regulation 2010 that an application is accompanied by any documents referred to in the approved form and by the relevant fees.

Any application form that is not accompanied by the relevant fees and supporting documents referred to in this form will be returned without further assessment.

Note: Inquiries may be undertaken by staff of the NSW Department of Primary Industries to verify information supplied within this application. It is an offence to provide false or misleading information.

OPPORTUNITY TO SUBMIT FURTHER INFORMATION AND CLARIFYAn application form that is accompanied by the relevant fees and documents will be reviewed by an assessor who will notify the applicant of any missing or unclear information and give the applicant 4 weeks (28 days) to submit the missing information and to clarify unclear information.

DECISIONOnce the 4 week period has passed the Secretary (or delegate) will either: a) decide to approve or refuse the application; or b) request advice from the Exhibited Animals Advisory Committee before making such a decision.

HOW LONG DOES IT TAKE?The NSW Department of Primary Industries attempts to make a final decision within 6 weeks of receiving an application to construct a fixed establishment or an off-display establishment. You should, however, submit your application well before you propose to commence construction as assessment may take longer, especially if the Department requires advice from the Committee. The Committee only meets once every three months.

LEASE AGREEMENTS

If you do not own the premises that you propose to use as a fixed establishment or off-display establishment then you must ensure that you have a written lease agreement with the owner giving you the legal rights to:

a) use the premises for these purposes;b) invite any other person on to the premises including any authorised inspectors; and c) do anything on those premises which may be required under the Exhibited Animals

Protection Act 1986 and Regulation in relation to your use of the premises. For example, this could include any alterations required to ensure that fence enclosures or animal enclosures are satisfactory. The NSW Department of Primary Industries is unable to provide legal advice to you on the terms of your lease agreements, and you should obtain your own legal advice if you have any concerns.

WHAT HAPPENS IF YOUR APPLICATIONS ARE APPROVED?

You are permitted, subject to the conditions of your approval, to construct the fixed establishment or off-display establishment proposed in your application.

On completion of construction, you should email [email protected] or contact Biosecurity and Food Safety Compliance on 02 6552 3000 to arrange an inspection of the completed fixed establishment or off-display establishment.

Following a satisfactory inspection, you will be required to pay the relevant issue fee ($285 for a Minor Exhibitor, otherwise $1035) and confirm that satisfactory insurance has been obtained.

A Minor Exhibitor means a person who exhibits or is going to exhibit no more than 30 animals. On receipt of your issue fee the NSW Department of Primary Industries will issue your

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Licence. You can only acquire an animal for exhibition if:

o the appropriate Licence (and Permit if applicable) has been issued; ando in the case of prescribed species, you have received approval to acquire the animal after

submitting an “Form F: Application to Acquire or Dispose of Animals” (see clause 32 of the Exhibited Animals Protection Regulation 2010 for exemption).

o you do not hold the same species under a licence issued by the Office of Environment and Heritage under the Biodiversity Conservation Act 2016.

WHAT HAPPENS IF AN APPLICATION IS REFUSED?

You will be advised in writing of the grounds for refusal. Your lodgement fees are non-refundable. You are eligible to reapply or to appeal to the NSW Civil and Administrative Tribunal within a

prescribed period.

GROUNDS FOR REFUSAL

Grounds for refusal of an application may include: The information provided indicates that the proposed fixed establishment or off-display

establishment will not conform to, and/or be conducted in accordance with, the prescribed standards.

Insufficient information has been provided to satisfy the NSW Department of Primary Industries that the proposed fixed establishment or off-display establishment will conform to, and/or be conducted in accordance with, the prescribed standards.

The applicant is not a fit and proper person to hold a licence due to the applicant:o providing false or misleading information.o having prior offences under the relevant legislation (See Question 6).

Failure of the applicant to withdraw the application within two weeks of the NSW Department of Primary Industries receiving advice that the applicant is no longer willing or able to construct a fixed establishment of off-display establishment at the premises indicated in the application. (Each application is specific to the address indicated and cannot be altered to apply to different premises. If the applicant wishes to construct a fixed establishment or off-display establishment at premises other than those indicated in the application then a new application must be made.)

PERMITS FOR CERTAIN ANIMALS

A Permit is required before certain species of animals may be exhibited. A list of these prescribed species can be found in Schedule 2 of the Exhibited Animals Protection Regulation 2010.

Exhibitors of these species must meet particular standards because of the special nature of these prescribed species. These animals are special because they meet one or more of the following descriptions:

1) Species that require specialist care and/or which pose a threat to keeper or public safety.

2) Species that are subject to studbooks or cooperative conservation programs conducted under the auspices of the Australasian Species Management Program of the Zoo and Aquarium Association.

You should review the list of species that you have provided under Question 13 to see if any of these are permit species. As stated above, for each permit species, you will need to submit a completed Form D: Application for a Permit to Exhibit a Prescribed Species.

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POSSESSION OF ANIMALS UNDER BOTH THE EXHIBITED ANIMALS PROTECTION ACT 1986 AND BIODIVERSITY CONSERVATION ACT 2016.

The Department of Primary Industries and the Office of Environment and Heritage (OEH) have a policy prohibiting exhibitors under the Exhibited Animals Protection Act 1986 holding the same species simultaneously under a licence issued under the Biodiversity Conservation Act 2016. This is required to avoid confusion in determining which individual animals are covered by which licence.

A person who holds a species under an OEH licence may not exhibit that species. To gain approval to exhibit that species the person must hold a relevant exhibitor’s authority (issued by the NSW Department of Primary Industries) and have obtained the approval of the NSW Department of Primary Industries to transfer all specimens of that species to the exhibitor’s authority. For example, if you have three blue tongue lizards on an OEH licence and wish to exhibit one of them under your NSW Department of Primary Industries animal display licence, you must first transfer all three blue tongues to the NSW Department of Primary Industries licence.

Please note that both the NSW Department of Primary Industries and if required the Office of Environment, and Heritage, will include a condition on your authorities that precludes any species being held under both authorities simultaneously. Any future changes to your collection will need to be in accordance with this condition.

If you need further information or assistance with completing the application form please contact the Exhibited Animal Licensing Unit on (02) 6552 3000.

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FORM A: APPLICATION TO CONSTRUCT* ANANIMAL DISPLAY ESTABLISHMENT (FIXED

OR OFF-DISPLAY ESTABLISHMENTS ONLY)

* “construct” means “erect” or “convert premises into”

Use this form to apply for approval to construct or convert premises into a fixed establishment or off-display establishment.

Lodgement Fee: $230

Type or use black ink (block letters). If there is insufficient space on the form, continue your answers on separate sheets, each of which should be signed and firmly attached.

1. APPLICANT DETAILS (Legal Entity)If the applicant is a sole trader, complete A only.If the applicant is a corporation or incorporated association, complete A and B.If the applicant is a government authority, complete A and C.

Note: partnerships are not eligible to apply.

A - All Applicants should complete this questionFor a sole trader – give personal details. For a corporation, incorporated association or government authority - give details of the organisation’s chief executive officer.

Mr, Mrs, Ms, Dr etc.      

Given Name(s)      

Surname      

Position Title      

Residential Address      

Postal Address      

Date of Birth      

Place of Birth      

Business Phone      

Fax      

Mobile Phone      

Email      

Website      

B - Corporations and incorporated associationsAttach a current ASIC print out showing all current company directors. (Mark it Attachment 1B)

Corporation Name      

Type of Corporation e.g. Ltd, P/L, Inc.

     

Date of incorporation      

Place of incorporation      

Departmental use only

20305 152-1 Exhibited Animals Application Receipt No.

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Postal Address      

Registered Office Address      

Street Address (if different to Registered Office Address)

     

Phone      

Fax      

Mobile Phone      

Email      

Website      

C – Government authorities

Name of Authority      

Postal Address      

Registered Office Address      

Street Address (if different to Registered Office Address)

     

Phone      

Fax      

Mobile Phone      

Email      

Website      

2. APPLICANT’S REPRESENTATIVE (INDIVIDUAL)The applicant authorises the following person to act on the applicant’s behalf to receive correspondence from, and submit information to the NSW Department of Primary Industries in relation to this application.

Position Title      

Mr, Mrs, Ms, Dr etc.      

Given Name(s)      

Surname      

Sample Signature

Postal Address      

Date of Birth      

Business Phone      

Fax      

Mobile Phone      

Email      

3. BUSINESS/TRADING NAME(S)Indicate below the proposed Business/Trading name(s) for the animal display establishment and attach a Certificate of Business Registration for each name. (Mark as Attachment 3).

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Business Name Registration certificate attached?Yes/No

           

           

           

Note: The name of the applicant and the name of the proprietor on the certificate of business registration must be the same.

4. DETAILS OF PREMISESA. Describe the premises at which the applicant proposes to construct the fixed establishment or

off-display establishment.

Street/Lot No.      

Street      

Suburb      

Post Code      

Folio Identifier      

Volume      

Folio      

B. Do you want only part of this property to be licensed? YES NO

C. If you answered ‘Yes’ to B, attach a copy of a surveyor’s plan indicating the boundary of the proposed establishment. (Mark as Attachment 4C)

D. Is the applicant the owner of the premises described above? YES NO

E. If you answered ‘No’ to D, what is the name and address of the owner or owner’s agent?

     

F. If you answered ‘No’ to D complete the following. I certify that:a) the applicant has the right to occupy the premises under a written lease agreement with the

owner named above;b) the lease allows the applicant to invite any other person on to the premises including any

authorised inspectors; c) the lease allows the applicant to use the premises as a fixed establishment or off-display

establishment and to do anything on those premises which may be required under the Exhibited Animals Protection Act 1986 and Exhibited Animals Protection Regulation 2010 in relation to the applicant’s use of the premises; and

d) the applicant has agreed to notify the NSW Department of Primary Industries immediately of any change in circumstances that affects the accuracy of these statements.

YES

G. Facilities, other than those for animal exhibition, which currently occupy these premises, are:

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Name      

Role of Facility (e.g. Theme Park)      

5. LOCAL COUNCIL APPROVALAttach a copy of all necessary Local Council approvals for the premises (or that part of the premises indicated in the response to 4C) to be used as an animal display establishment. (Mark as Attachment 5)

Copy attached? YES NO

Note: This application cannot be approved unless notice of approval is submitted.

6. PRIOR OFFENCES, REFUSALS OF APPLICATIONS, ETC.Has the applicant or any person with a proprietary or management role in the proposed fixed establishment or off-display establishment:

had an application refused; or been convicted of any offence; or a charge pending for any offence;

under the:

a) Exhibited Animals Protection Act 1986? YES NO

b) Prevention of Cruelty to Animals Act 1979? YES NO

c) Animal Research Act 1985? YES NO

d) Biosecurity Act 2015? YES NO

e) Biodiversity Conservation Act 2016? YES NO

f) Other equivalent Commonwealth, State or Territory statutes or Regulations made under those statutes? YES NO

If you answered 'yes’ to any of the above offences, provide full details – including the offence, year, pleads of guilty, and sentencing that outlines any convictions recorded.     

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7. POSSESSION OF A LICENCE UNDER THE BIODIVERSITY CONSERVATION ACT 2016

Do you hold a licence under the Biodiversity Conservation Act 2016 issued by the Office of Environment and Heritage?

YES NO

If you answered ‘Yes’ complete the following:

I certify that I will not hold animals of the same species under both an Exhibited Animals Protection Act 1986 authority and a licence issued under the Biodiversity Conservation Act 2016.

YES

8. ACT, REGULATION AND STANDARDSAttach a photocopy of the front page of the Exhibited Animals Protection Act 1986 and the Exhibited Animals Protection Regulation 2010, and all relevant prescribed exhibit standards to show that you have obtained these documents. (Mark as Attachment 8)

9. PUBLIC RISK INSURANCEAttach details of the public risk insurance policy that will cover your animal display operation. It is acceptable to include a copy of a quotation with this application however ordinarily a satisfactory policy giving cover for at least $10 million must be in effect before an animal display establishment licence can be issued. (Mark as Attachment 9)

Note: the name of the applicant and the name of the insured on the public liability policy must be the same.

10. FIRST AIDIndicate the type of first aid kit that will be provided for the use of visitors.

     

11. HYGIENEDescribe the hand washing facilities that will be provided for members of the public who are allowed to contact animals.

     

12. OPENING DETAILSFor a fixed establishment:A. Proposed date of opening to the public:

B. Proposed regular opening and closing times:Mon Tues Wed Thurs Fri Sat Sun

Open                                          

Close                                          

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C. Other occasions when the fixed establishment may be open to the public:     

13. SPECIES LIST AND PERMIT APPLICATIONSA. Provide details of the number of each species of vertebrate animal that you wish to exhibit during

the first year of operation.

Note: The possession of the same species under both an Exhibited Animals Protection Act 1986

authority and a Biodiversity Conservation Act 2016 licence is prohibited. See the Information for Applicants section and Question 7 for more details.

Licence issue fees can be minimised by restricting the number of animals to 30 or less. Failure to include appropriate common and scientific names is unacceptable.

Common Name Scientific NameNumbers Permit

Species (Y/N)M F U Total

                                    

                                    

                                    

                                    

                                    

                                    

                                    

                                    

                                    

                                    

                                    

                                    

TOTAL NUMBER OF ALL ANIMALS                    

B. Attach a fully completed “Form D: Application for a Permit to Exhibit a Prescribed Species” for each prescribed species you have listed in your answer. Prescribed species are listed in Schedule 2 of the Exhibited Animals Protection Regulation 2010. Each Form D must be accompanied by a $23 lodgement fee and any documents referred to in the Form D. (Mark as Attachment 13B)

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14. ANIMAL DIETFor each species listed, attach a description of the diet you propose providing, including frequency of food provision, seasonal alternatives and variations such as starve days. (Mark as Attachment 14)

15. ANIMAL IDENTIFICATIONFor each species listed, explain the technique you will use to identify the individual animals.

Identification Technique(e.g. Leg Bands, Ear Tags, Microchips, etc) Species

           

           

           

           

           

           

           

           

           

           

           

           

           

           

           

           

           

16. VETERINARY SERVICESA. Describe arrangements for the provision of regular veterinary inspection of each animal.

     

B. Attach a letter from your proposed veterinarian stating his/her willingness to undertake routine veterinary treatment of the species you plan to hold. (Mark as Attachment 16B)

17. PLAN OF THE FIXED ESTABLISHMENT OR OFF-DISPLAY ESTABLISHMENTAttach an in-scale plan view of the proposed fixed establishment or off-display establishment (Mark as Attachment 17), including the following details:

a) A titleb) Name of applicantc) Address of proposed fixed establishment or off-display establishment

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d) Direction of true northe) Drawing numbers and revisions, if applicablef) Drawing scale/sg) Name of draftsperson/architect and date of planh) Specifications of the total area of the premisesi) The proposed location of each animal enclosure and support facility on the premisesj) A fence for the outer boundary of the establishmentk) Roads, walkways and car parksl) Storage for food, hoists, machines, tools, building materials, landscaping materials and

vehiclesm) Entrances, catering, shops, toilets and hand-washing facilities for public/staff, shelter and

seating for visitorsn) Veterinary buildings with isolation or quarantine facilitieso) Water, electricity, and gas supplies, fuel storage, chemical storage, and greenhousesp) Waste disposal and drainageq) Any existing structures and facilities on the proposed premises, andr) Any structures or modifications not listed above

18. ANIMAL ENCLOSURESAttach a fully completed “Form G: Application for Approval for Construction or Alteration at a Fixed Establishment or Off-display Establishment” for each animal enclosure proposed to form part of the proposed fixed establishment or off-display establishment. Each Form G must be accompanied by a $46 lodgement fee and any documents referred to in the Form G. (Mark as Attachment 18)

Have you attached a Form G for each:

a) display enclosure YES

b) off-display enclosure YES

c) health management enclosure YES

d) animal treatment area YES

e) outer property fence and gates YES

19. SUPPORT FACILITIESAttach a fully completed “Form G: Application for Approval for Construction or Alteration at a Fixed Establishment or Off-display Establishment” for each of the following support facilities proposed to form part of the proposed fixed establishment or off-display establishment. Each Form G must be accompanied by a $46 lodgement fee and any documents referred to in the Form G. (Mark as Attachment 19)

Have you attached a Form G for the:

a) food preparation area YES

b) feed storage facilities YES

c) post mortem facilities YES

20. EDUCATIONIn the case of a fixed establishment, attach an Educational Proposal that demonstrates that the establishment will provide appropriate education to the public concerning the conservation of animals. (Mark as Attachment 20)

This document shall include, for each display enclosure:

a) a description of how the exhibit will be furnished and landscaped to provide a naturalistic setting which resembles the animal's habitat, and either

b) the wording proposed for the information signs required by clause 6 of the General Standards

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for Exhibiting Animals in New South Wales; and/orc) details of audio/visual/handout material which will be given to the public, e.g. regular talks,

guided tours, pamphlets etc.

21. STAFF A. For each person who will be caring for the animals, or who will be making animal management

decisions, attach a résumé that details their qualifications and experience directly relevant to the care and management of the species listed in this application. (Mark as Attachment 21A)

Note: An animal exhibit operation needs to employ sufficient appropriately qualified* staff to ensure continuous high quality animal welfare and management of the facilities and to cover absences during sickness and annual leave. Applications proposing to employ fewer than two appropriately qualified staff will not normally be approved.

*”Appropriately qualified staff” means they hold Certificate III in Captive Animal Management or equivalent. Include a copy of appropriate certificates within Attachment 21A.

B. List (in order of authority) the numbers and types of staff you propose to employ during your first year of opening to the public.

Position TitleNumber

to beEmployed

ResponsibilitiesFull-time,Part-time,Voluntary

Certificate III in Captive

Animal Management

(Y/N)

                             

                             

                             

                             

                             

                             

                             

                             

                             

                             

22. APPLICATION FEEThe fees payable are:

$230 lodgment fee for an Application for Approval to Construct an Animal Display Establishment (Fixed or Off-display Establishments Only) (Form A)

$23 for each Application for a Permit to Exhibit a Prescribed Species (Form D).

$46 for each Application for Approval for Construction or Alteration at a Fixed Establishment of Off-display Establishment form (Form G).

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Page 15: Form A: Application to construct an animal display ... · Web view(credit card details may be provided – see page 11), and all documents referred to in the application form (including

Application Fee Calculator

Form Number of Applications Price per Application Total

Form A 1 X $230 $230

Form D       X $23 $     

Form G       X $46 $     

Grand Total $     

Select payment method

Cheque(Payable to NSW Department of Primary Industries)

Money order (Payable to NSW Department of Primary Industries)

Credit Card (see below)

Payment Amount      

Type of Card Visa Mastercard

Card No. (16 digits)                    

Credit card verification number (security number)    

Expiry   /  

Cardholder’s Name      

Cardholder’s Signature

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Page 16: Form A: Application to construct an animal display ... · Web view(credit card details may be provided – see page 11), and all documents referred to in the application form (including

DECLARATION

I certify that to the best of my knowledge, the above answers are correct and complete and that I am aware of the relevant provisions of the Exhibited Animals Protection Act 1986, Prevention of Cruelty to Animals Act 1979, Biosecurity Act 2015, the Biodiversity Conservation Act 2016 and Regulations made under those Acts and by reason of my knowledge, experience and facilities can reasonably be expected to comply with their requirements.

I understand that a further issue fee must be paid before an animal display establishment licence can be issued. I acknowledge that providing false or misleading information is an offence under the Act.

I acknowledge that construction of facilities will not commence until permission has been granted.

I consent to staff of the NSW Department of Primary Industries contacting any referees to verify experience and make other enquiries to confirm information provided within this application. This may include consulting with industry experts to obtain specialised advice.

To be signed by the person whose details appear in Question 1A.

Name      

Position Title      

Signature

Date      

Return the completed form by:

Preferred method: emailing a pdf of the completed, signed form/s, attachments and credit card details to [email protected]

or Posting the completed, signed form/s and attachments, including lodgement fees, to:

Exhibited AnimalsBiosecurity and Food Safety Compliance The Department of Primary Industries Locked Bag 21ORANGE NSW 2800

For more information or for assistance completing the form, contact the Exhibited Animal Licensing Unit on 02 6552 3000.

Privacy: The information collected in this form will be stored securely and used only for the purposes for which it has been collected. See our full privacy policy http://www.trade.nsw.gov.au/legal/privacy

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Page 17: Form A: Application to construct an animal display ... · Web view(credit card details may be provided – see page 11), and all documents referred to in the application form (including

APPLICANT’S CHECK LIST

1) Applicant details2) Details of Representative acting on Applicant’s behalf3) Business and trading name – including Certificate of Business/Trading name4) Fixed or off-display establishment details

a) Premises description b) Part of property to be licensedc) Surveyor’s plan of part d) Applicant is owner? e) Name and address of the owner of the premisesf) Lease declarationg) Details of facilities other than for animal exhibition

5) Local council approval to construct a fixed or off-display establishment6) Details of any prior offences7) Possession of a licence under the Biosecurity Conservation Act 20168) Attach copies of the front page of the Act, Regulation and relevant standards9) Public risk insurance certificate10) First aid equipment11) Hygiene - hand washing facilities12) Opening details (for a fixed establishment)

a) Proposed opening dateb) Opening and closing timesc) Other occasions

13) Species list and Permit (Form D) applicationsa) List of each species proposed to be displayedb) Permit application (Form D) for each prescribed species (including $23 fee per

species + supporting documents)14) Diets for each species 15) Animal identification16) Veterinary services17) Plan of the establishment18) “Form G” Application for each animal enclosure

(including $46 fee per species + supporting documents) 19) “Form G” Application for each support facility

(including $46 fee per species + supporting documents)20) Education proposal (for a fixed establishment) .21) Staff

a) Résumé and certificates of each staff memberb) Numbers and types of staff

22) Application fees paid23) Declaration24) Make and keep a copy of this application

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